2017-11-07T18:29:14-06:00 2016-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2016-01-01 112388200 COBBLE HILL HEALTH CENTER INC COBB 7188556789 380 HENRY STREET BROOKLYN NY 11201 ANTHONY LEWIS PRESIDENT/CEO 7188556789 2017-11-07 1 AARON SHAPIRO P01333816 2128674000 38.98.118.70 2017-11-07 17:26:28 ES P D7076C0EC39B17C3336BFEA465ABF20A32036F2A 73A2BDB4DEE3E1301F7FB9DCBA9193E2BC5F7900 2016 2021-01-29 14:40:06Z ANTHONY LEWIS 380 HENRY STREET BROOKLYN NY 11201 67479478 0 X WWW.COBBLEHILL.ORG X 1977 NY TO MAINTAIN A NURSING FACILITY AND PROVIDE ADULT DAY CARE AND LONG TERM HOME HEALTH SERVICES ON AN OUTPATIENT BASIS. 8 8 579 240 0 0 231090 172497 52093771 47446683 660425 266797 56556 -113101 53041842 47772876 0 32569 0 0 28969952 29406844 0 0 0 18862673 18777003 47832625 48216416 5209217 -443540 95320512 92424849 52701372 48354848 42619140 44070001 X COBBLE HILL HEALTH CENTER, INC. (CENTER)OPERATES A 364 BED NURSING FACILITY. THE CENTER PROVIDES NURSING CARE TO PATIENTS AND IS LICENSED TO PROVIDE ADULT DAY CARE SERVICES. IN ADDITION, THE CENTER PROVIDES A LONG-TERM HOME HEALTH CARE PROGRAM. 0 0 40845906 32569 44762126 SEE SCHEDULE O.THE CENTER HAS BEEN PROVIDING RESIDENTIAL AND COMMUNITY BASED SERVICES TO THE DISABLED AND ELDERLY FOR OVER 30 YEARS. THE CENTER OFFERS A COMPLETE RANGE OF MEDICAL, NURSING AND REHABILITATION SERVICES. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:>SUBACUTE CARE MEDICAL CARE, THE GOAL OF WHICH IS TO ENSURE A QUICK AND COMPLETE RECOVERY THEREBY RESTORING OUR RESIDENTS INDEPENDENCE AND HELP THEM RETURN TO COMMUNITY LIVING; >LONG TERM CARE, WHICH OFFERS A HOME-LIKE ALTERNATIVE THAT PROVIDES EACH INDIVIDUAL WITH HIS OR HER SPECIFIC NEEDS, BE IT PHYSICAL, PSYCHOLOGICAL OR EMOTIONAL, IN AN OPTIMUM ENVIRONMENT ENSURING THAT QUALITY OF LIFE IS MAINTAINED;>REHABILITATION, WHOSE GOAL IS TO RESTORE RESIDENTS FUNCTION AND THE ABILITIES THEY HAD PRIOR TO THE ONSET OF ILLNESS, INJURY OR TRAUMA; >A DIALYSIS CENTER, WHERE TREATMENT IS CONVENIENT BECAUSE IT IS ADMINISTERED ON-SITE AND PROVIDES MINIMAL DISRUPTION OF THEIR REGULAR SCHEDULES AND LIVES; >ALZHEIMERS SPECIAL CARE, WHICH, FOR OVER A DECADE, HAS LED THE WAY IN CARING FOR INDIVIDUALS WITH ALZHEIMERS DISEASE. THROUGH PROGRAM DEVELOPMENT, RESEARCH AND TRAINING,OUR ALZHEIMERS UNIT HAS RECEIVED THE BEST PRACTICES AWARD.THE CENTER PROVIDED 130,955 DAYS OF SKILLED NURSING CARE IN 2016. 2182689 2684557 THE CENTER, THOUGH ITS WHOLLY OWNED SUBSIDIARY COBBLE HILL LIFECARE PLUS, LLC (CHLCP), PROVIDES CARE MANAGEMENT SERVICES TO AETNA BETTER HEALTH MEDICAID MANAGED LONG TERM CARE PLAN (MLTC). A STAFF OF APPROXIMATELY THIRTY MULTILINGUAL NURSES, SOCIAL WORKERS AND CLERICAL SUPPORT STAFF PROVIDE TELEPHONIC CARE MANAGEMENT TO APPROXIMATELY 13,000 AETNA MEMBERS IN BROOKLYN, MANHATTAN AND QUEENS IN 2016. 43028595 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 58 0 579 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 NY X NEIL SCHLISSEL 7188556789 380 HENRY STREET BROOKLYN NY 11201 THOMAS SPATH CHAIR 1.00 1.25 X X 0 0 0 PAUL SAYEGH TREASURER 1.00 1.25 X X 0 0 0 W RUDY KAMUF SECRETARY 1.00 1.75 X X 0 0 0 CHARLIE CARAMES BOARD MEMBER 1.00 0.25 X 0 0 0 GREG O'CONNELL BOARD MEMBER 1.00 0.25 X 0 0 0 LEONARD T JORDAN BOARD MEMBER 1.00 0.25 X 0 0 0 JOAN MILLMAN BOARD MEMBER 1.00 0.25 X 0 0 0 PETER D YATRAKIS BOARD MEMBER 1.00 0.25 X 0 0 0 JOSEPH BROADWIN BOARD MEMBER (UNTIL 11/16) 1.00 0.25 X 0 0 0 PATRICK OWEN BURNS BOARD MEMBER (UNTIL 11/16) 1.00 0.25 X 0 0 0 ANTHONY LEWIS PRESIDENT / CEO 30.00 8.00 X 293090 25486 45536 DANIEL TUCHMAN ADMINISTRATOR / COO 30.00 8.00 X 276577 87735 60181 ALAN GROSS CFO 30.00 6.00 X 320281 75127 51915 MAMERTO ALVAREZ MAINTENANCE SUPERVISOR 35.00 X 161219 0 36674 RAISA FORKOSH ADMISSIONS DIRECTOR 35.00 X 160010 0 38656 VIRGINIA COHEN CHLCP DIRECTOR 35.00 X 136472 0 28025 PAT SLINGER-HARVEY DIR. OF FOOD & NUTRITION 35.00 X 131274 0 36190 MEVE SHAKESPEARE DIRECTOR OF NURSING 35.00 X 130541 0 21943 1609464 188348 319120 25 0 1 0 THERADYNAMICS REHAB 225 CROSSWAYS PARK DRIVE WOODBURY NY 11797 NURSING AGENCY/THERAPY SERVICES 1978580 PHARMSCRIPT LLC 150 PIERCE STREET SOMERSET NJ 08873 PHARMACEUTICAL AGENCY 659329 WHITE GLOVE PLACEMENT 85 BARTLETT STREET BROOKLYN NY 11206 NURSING AGENCY 537331 UNITEX TEXTILE 401 SO MACQUESTEN PKWY MT VERNON NY 10550 LAUNDRY AGENCY 480088 FHS CONSULTANTS 2636 NOSTRAND AVENUE BROOKLYN NY 11210 HEALTHCARE CONSULTING AGENCY 349100 12 150000 22497 172497 SKILLED NURS. FACILITY 623000 44762126 44762126 CASE MANAGEMENT 624100 2684557 2684557 47446683 260582 260582 40000 174423 -134423 -134423 -134423 19538394 19532179 6215 6215 6215 MEDICAL RECORDS 900099 15465 15465 VENDING MACHINE 900099 3102 3102 2755 2755 21322 47772876 47446683 0 153696 32569 32569 1019626 1019626 20575996 19429586 1146410 1803119 1687875 115244 4153709 3789310 364399 1854394 1668750 185644 125139 125139 423626 423626 199182 199182 4976 4976 67290 67290 4536466 4127099 409367 20956 18858 2098 3824604 3441770 382834 372317 335044 37273 3314029 2964798 349231 23496 21144 2352 2613496 2351858 261638 905818 815136 90682 CASH RECEIPTS ASSESSMEN 2337516 2337516 8092 7282 810 48216416 43028595 5187821 0 4753129 5344527 2501267 2584252 8826810 9772821 58860 50332 211956 111651 80578027 29156865 53092868 51421162 11783274 12389767 14092348 10750337 95320512 92424849 4678314 4043787 35450000 33337189 316643 342151 12256415 10631721 52701372 48354848 X 42525021 43969583 94119 100418 42619140 44070001 95320512 92424849 X -443540 270107 1624294 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4976 4976 0 PART II-B, LINE 1: THE $4,976 IS AN ALLOCATION OF TRADE ASSOCIATION DUES FOR LOBBYING EXPENSES. 0 1 X 237000 237000 73517911 23795985 49721926 4493354 3141602 1351752 2329762 2219278 110484 51421162 DUE FROM COBBLE HILL FOUNDATION, INC. 125947 DUE FROM YOUR CHOICE AT HOME, INC. 445964 DEPOSITS AND OTHER RECEIVABLES 97202 DUE FROM THIRD PARTIES 10081224 10750337 DUE TO THIRD PARTIES 32669 SWAP AGREEMENTS 10599052 10631721 X 48150116 270107 174423 444530 47705586 67290 67290 47772876 48323549 174423 174423 48149126 67290 67290 48216416 PART IV, LINE 2B: RESIDENT PERSONAL FUNDS ARE MAINTAINED IN BANK ACCOUNTS SEPARATE FROM THE CENTER'S ACCOUNTS. INTEREST EARNED ON RESIDENT FUNDS IS CREDITED TO THE RESIDENTS' ACCOUNTS. PART X, LINE 2: THE CENTER HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2013 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 174,423. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 174,423. 1 NEW YORK METHODIST HOSPITAL 506 SIXTH STREET BROOKLYN NY 11215 111631796 501(C)(3) 10000 HEALTH CARE THE BROOKLYN HOSPITAL FOUNDATION 121 DEKALB AVENUE BROOKLYN NY 11201 112936410 501(C)(3) 10000 HEALTH CARE 2 0 PART I, LINE 2: THE GRANTS ARE APPROVED BY THE BOARD OF DIRECTORS PRIOR TO THE FUNDS BEING TRANSFERRED. THE APPROVAL IS BASED ON DOCUMENTS SUBMITTED BY THE GRANTEES IN REQUEST OF THE GRANTS. MANAGEMENT PERFORMS A SUBSEQUENT REVIEW TO ENSURE THE FUNDS WERE USED AS INTENDED. THIS INCLUDES REVIEW OF REPORTS OF THE USE OF THE FUNDS SUBMITTED BY THE GRANTEES. X X X 0 0 0 0 0 0 0 1 0 ANTHONY LEWIS PRESIDENT / CEO 272850 23726 20240 1760 0 0 28423 2472 13470 1171 334983 29129 0 0 DANIEL TUCHMAN ADMINISTRATOR / COO 259857 82455 16720 5280 0 0 23480 7415 22257 7029 322314 102179 0 0 ALAN GROSS CFO 302043 70947 17820 4180 418 0 25025 5870 17026 3994 362332 84991 0 0 MAMERTO ALVAREZ MAINTENANCE SUPERVISOR 151062 0 10000 0 157 0 16717 0 19957 0 197893 0 0 0 RAISA FORKOSH ADMISSIONS DIRECTOR 149845 0 10000 0 165 0 16645 0 22011 0 198666 0 0 0 VIRGINIA COHEN CHLCP DIRECTOR 136324 0 0 0 148 0 14482 0 13543 0 164497 0 0 0 PAT SLINGER-HARVEY DIR. OF FOOD & NUTRITION 130134 0 1000 0 140 0 14163 0 22027 0 167464 0 0 0 MEVE SHAKESPEARE DIRECTOR OF NURSING 90541 0 5000 0 35000 0 0 0 21943 0 152484 0 0 0 PART I, LINE 7 THE BOARD APPROVES MERIT BASED BONUSES FOR ITS OFFICERS AND TOP EMPLOYEES FOR THEIR DEDICATION TO THE CENTER DURING THE YEAR. THESE BONUSES ARE APPROVED TOWARDS THE END OF THE YEAR. A NYC CAPITAL RESOURCE CORP 204099098 649437AEO 2008-01-30 35920000 RENOVATION 0 0 0 B NYC CAPITAL RESOURCE CORP 204099098 649437AF7 2008-01-30 4420000 REFINANCING 1 0 0 C NYC CAPITAL RESOURCE CORP 204099098 649437AG5 2008-01-30 7850000 CONSTRUCTION 0 0 0 A 35920000 12137676 1331784 22448875 2011 1 0 0 1 B 4420000 4261307 158691 2008 1 0 0 1 C 7850000 286416 7438143 2009 1 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 C 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CFO AND PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. ANY QUESTIONS THAT ARISE ARE DISCUSSED AND RESOLVED PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CENTER REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICT. THIS INFORMATION IS REVIEWED BY THE AUDIT AND CORPORATE COMPLIANCE COMMITTEES. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING ANY CONFLICTS OF INTEREST WHICH OCCUR, AND WILL ENSURE SUCH INDIVIDUALS DO NOT PARTICIPATE IN DISCUSSIONS OR DECISIONS INVOLVING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED BY A RECOMMENDATION BY THE PRESIDENT/CEO AND APPROVAL OF THE BOARD. THE PRESIDENT/CEO'S COMPENSATION IS DETERMINED BY THE GOVERNING BOARD. THIS PROCESS WAS LAST DONE IN 2015. THE PROCESS INCLUDES A BOARD REVIEW OF COMPENSATION OF SIMILAR POSITIONS AT OTHER HEALTH CARE FACILITIES OBTAINED FROM IRS FORM 990S FILED ON GUIDESTAR OR CANVASSING OF THOSE FACILITES. FORM 990, PART VI, SECTION C, LINE 19 THE CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SWAP AGREEMENT 1,624,294. FORM 990, PART XII, QUESTION 12C: THE PROCESS DID NOT CHANGE FROM PRIOR YEAR. COBBLE HILL LIFECARE PLUS LLC 380 HENRY STREET BROOKLYN NY 11201 461226428 PROVIDES CARE MANAGEMENT SERVICES FOR THE ELDERLY LIVING AT HOME NY 2684557 0 COBBLE HILL HEALTH CENTER INC COBBLE HILL FOUNDATION INC 380 HENRY STREET BROOKLYN NY 11201 113122301 FUNDRAISING NY 501(C)(3) PF N/A 0 YOUR CHOICE AT HOME INC 380 HENRY STREET BROOKLYN NY 11201 461256502 HOME HEALTH CARE NY 501(C)(3) LINE 10 N/A 0 COBBLE HILL LIFECARE INC 380 HENRY STREET BROOKLYN NY 11201 461388106 SUPPORTING ORGANIZATION NY 501(C)(3) LINE 12B, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0